The Centers for Medicare and Medicaid Services reports that one in six persons older than 65 suffers from depression and that depression in older patients occurs in 25% of those with other physical illnesses. Furthermore, a review of research by the U.S. Preventive Services Task Force indicated that depression screening and depression care support improve clinical outcomes in adults and older adults.
Medicare began covering annual depression screening conducted within a primary care setting in October 2011. Medicare will reimburse for an annual depression screen for adult beneficiaries covered under the fee-for-service program conducted within a primary care setting that includes staff-assisted depression care supports in place to ensure accurate diagnosis, effective treatment and follow-up.
At a minimum, staff-assisted depression care supports consist of clinical staff (e.g., nurse, physician assistant) in the primary care office who can advise the physician of screening results and who can facilitate and coordinate referrals for necessary mental health treatment. More comprehensive services can be provided based on screening results and patient preference, including treatment initiation within the primary care setting, patient education and support for patient self management, and collaborative interactions with any mental health professional to whom a patient is referred.
The new benefit will cover one screening for depression over a 12-month period. The service code is G0444 (with a relative value unit of 0.51). Attach modifier 25 to the evaluation and management (E/M) code related to the visit to clarify that the depression screening claim is independent of the E/M service. Any treatment provided as a result of the screening should be bundled into the E/M claim. Because this is a Medicare preventive service, there is no deductible or co-insurance payment required from the beneficiary.
The Patient Health Questionnaire (PHQ-9) is the most frequently used screening measure in the primary care setting. This nine-question, self-administered survey can be completed by the patient in the waiting room and then quickly scored by staff before the patient sees the physician. Alternatively, staff or the physician can orally present the first two questions to the patient and only require the full PHQ-9 if the patient obtains a score of two or more on either item. The PHQ-9 is online.
Consider reviewing the following available resources for further information:
- The ACP Depression Treatment Guide. CME credits are available from this activity.
- The Brief Depression Screening Toolkit developed by the Behavioral Health Workgroup of the Patient Centered Primary Care Collaborative. This includes a description of the benefit, a copy of PHQ-9, and treatment considerations based on the results of the screening tool.
- "Screening for Depression in Adults, " developed by CMS to inform physicians and other clinicians about this new Medicare benefit. This is available by placing code 7637 in the Medicare MLN Matters document search tool.